2019 Supplemental Claims Impact

Risk score accuracy continues to be a hot topic in the ACA marketplace – especially with COVID reducing hospital visits. Supplemental files allow issuers to ensure accurate coding for risk scoring, thus impacting risk adjustment transfers in the ACA market. In addition, supplemental files also help issuers mitigate risk adjustment data validation (RADV) audit risk for both “under-coding” and “over-coding” by correcting data within their claims system.

This paper provides information related to supplemental claim information collected through the 2019 Wakely National Risk Adjustment Reporting (WNRAR) project. The average impact of supplemental data to risk scores and industry insights are provided in the paper.